Exercise 05 · Full guide · Access
Access Needs Map.
Access isn’t a one-off disclosure. It’s part of how therapy works.
A map, written by the client, of what makes therapy itself work for them. It’s reviewed regularly, and it treats access as normal and ongoing for every client, not only those who identify as disabled.
1Why this exercise exists
Most therapy is set up around an assumed client: who can travel, sit for 50 minutes, speak fluently, make eye contact, and manage the same time every week. Clients who don’t fit have to ask for changes, often repeatedly, and often while worrying about seeming difficult.
Research with disabled adults has found that many have had to educate their therapists, and that accommodating client preferences is linked with lower dropout. Asking about access routinely takes that work off the client.
The map also helps when things go wrong. If the client has said what overwhelm looks like for them, or how they’d like you to check in, a rupture is easier to notice and repair.
2The thinking behind it
Access intimacy
The disabled writer and organiser Mia Mingus describes a kind of closeness that comes when access is understood without a fight: “Access intimacy is that elusive, hard to describe feeling when someone else ‘gets’ your access needs.” The Access Needs Map is one way to make that more likely in therapy.
Preferences and outcomes
A meta-analysis by Swift and colleagues (2018) found that clients whose preferences about therapy were accommodated were less likely to drop out and had slightly better outcomes. Rhoda Olkin’s work on disability-affirmative therapy describes adapting the setting and frame as part of good practice, not a favour.
The law
In the UK, the Equality Act 2010 requires service providers to make reasonable adjustments for disabled people. In Ireland, the Equal Status Acts require reasonable accommodation. Neither depends on a diagnosis letter, and good practice goes beyond the legal minimum.
Why every client
Many people have access needs without calling themselves disabled: a parent who can only do evenings, someone with migraines, a client who processes slowly. Offering the map to everyone makes access ordinary, and means nobody has to disclose to be accommodated.
3What it looks like in a session
Fictional example Lena, 33, is autistic and has had three therapists before. In her first session she says she’ll “just go along with whatever you usually do”.
I don’t want to be difficult.
Can I show you something I use with everyone? It’s seven areas: format, timing, communication, sensory, body, emotional safety, and what helps when things go wrong. You can fill in as much or as little as you like.
Can I do it in writing, after the session?
Of course. That’s already the first thing on it.
…Camera off for the first ten minutes. And please don’t ask me how something “feels” straight away. I need to think first.
Lena sends a short written map the next day. The therapist reads it back at the start of session two, agrees what they can do, and says honestly that they can’t offer evening sessions. A review is set for six weeks.
4How to run it
Share the areas before the session if you can, in the client’s preferred format. Partial is fine, and so is “I don’t know yet”.
- Before
Share the areas in advance
Send the seven areas in writing, or offer them at the start. Say that every client gets them.
“I ask everyone about this, so we can make sessions work for you.”
Why: Framing it as routine removes the sense of special pleading.
- 10 minutes
Fill in together, or let the client do it alone
Go area by area, letting the client skip any. Write in their words.
“What helps you take part? What makes it harder?”
Why: The client’s words matter more than tidy categories.
- 3 minutes
Agree what you can offer now
Go through each need. Say yes, say what you’ll try, and say honestly what you can’t do yet.
“I can do this; I’ll try this; this one I can’t, and here’s why.”
Why: Honesty about limits builds more trust than vague agreement.
- 2 minutes
Set a review date
Agree when you’ll look at it again, and that either of you can raise it sooner, especially after a rupture or health change.
“Shall we look at this again in six weeks?”
The seven areas
| Area | Example prompts |
|---|---|
| Format | Online or in person? Camera on or off? Text chat alongside? |
| Timing | Session length? Time of day? Breaks? Flexible cancellation on bad days? |
| Communication | Pace, plain language, written summaries, AAC, interpreter, processing time? |
| Sensory | Lighting, sound, scent, movement, fidget items? |
| Body | Positioning, rest, pain flare plans? |
| Emotional safety | Topics to approach slowly? What does overwhelm look like for you? |
| When it goes wrong | How would you like me to check in, or repair? |
5Adapting it
| If… | Try |
|---|---|
| The client doesn’t know their needs yet | Start with the 30-second access check, and fill the map in over time. |
| Writing is hard | Talk it through, and you write it down for them to check. |
| The client uses AAC | Share the areas in advance so they can prepare answers. |
| Couples or family work | Map each person, and note where needs conflict. |
| Short-term or single-session work | Use only Format, Communication and When it goes wrong. |
6Through different approaches
The exercise sits inside most ways of working. What changes is what you do with what comes up.
Pluralistic
The map is shared decision-making about methods, made explicit.
“What would make this work for you?”
Person-centred
Use it to show unconditional positive regard in practical form.
“There’s no wrong answer here.”
CBT
Build it into the first-session contract and review it with goals.
“What do you need from sessions so you can use them?”
Psychodynamic
Notice what it means to the client to be asked, and to ask.
“What was it like to say what you need?”
Trauma-informed
Give choice and control from the very start.
“You decide what goes on here, and you can change it.”
Group and service level
Offer it as standard at intake across a service.
“We ask every client the same seven questions.”
7Signs it’s helping, and when to hold back
Signs it’s helping
- The client asks for an adjustment without apologising.
- Fewer missed sessions for access-related reasons.
- Ruptures get named earlier, using the client’s own words.
- The map gets updated, not filed away.
- The client says therapy feels more usable.
When to hold back
- Don’t make it a gate to starting therapy.
- Never require a diagnosis or proof.
- If you can’t meet a need, say so and help find someone who can.
- Don’t treat it as a one-off form. Review it.
8Printable worksheet
My access needs map · Date: __________
What makes therapy work for me
What we agreed, and what can’t happen yet
Review date
9Evidence & sources
- Established conceptMingus, M. (2011, May 5). Access intimacy: The missing link. Leaving Evidence. leavingevidence.wordpress.com
- Research findingSwift, J. K., Callahan, J. L., Cooper, M., & Parkin, S. R. (2018). The impact of accommodating client preference in psychotherapy: A meta-analysis. Journal of Clinical Psychology, 74(11), 1924–1937.
- Research findingConner, K. J., et al. (2023). Psychotherapy experiences of U.S. adults with physical disabilities: Recommendations for affirmative practice. The Counseling Psychologist, 51(7), 970–1004. doi:10.1177/00110000231186824
- Established conceptOlkin, R. (1999). What Psychotherapists Should Know About Disability. Guilford Press.
- Clinical guidanceEquality Act 2010 (UK), duty to make reasonable adjustments; Equal Status Acts 2000–2018 (Ireland), reasonable accommodation.
- Our frameworkThe seven-area map is this site’s own tool.
Related: Accessibility & Therapy · Reasonable Adjustments · Accessible Intake & Consent · All eleven exercises